腹腔镜保留脾脏的胰腺远端切除术  

Clinical investigation of spleen-preserving laparoscopic distal pancreatectomy

作　　者：戴梦华[1] 赵玉沛[1] 

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100730

出　　处：《中华普外科手术学杂志（电子版）》2013年第3期32-32,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然科学基金项目(81071898)

摘　　要：随着腹腔镜技术的发展以及对脾脏功能的认识的不断深入,腹腔镜保留脾脏的胰体尾切除手术成为胰腺远端良性或者低度恶性肿瘤的首选术式。保留脾脏血供的主要方式有保留脾脏血管的Kimura法和不保留脾脏的Warshaw法。Kimura方法的主要技术环节是先分离远端胰腺与脾脏血管,离断胰腺后,将远端胰腺提起,分离脾脏血管与胰腺后方,离断入远端胰腺的分支血管,完整切除远端胰腺,同时保留脾脏的血管。Warshaw方法的技术环节是离断胰腺后,同时离断脾脏动静脉,在脾门切除胰腺同时切除脾门主要血管,注意保留胃短血管和胃网膜左血管如脾脏分支。注意观察脾脏颜色,以避免脾梗死的发生。当术中脾静脉受到损伤时,Warshaw方法不失为另一种有效的保留脾脏方法。With the development of laparoscopic technique, and the further understanding of splenic function, the significance of preserving the spleen has recently been shown and spleen-preserving becomes more and more popular in laparoscopic distal pancreatectomy . spleen-preserving distal panereatectomy will be the first selected procedure in patients with benign or low-grade malignant tumors in the body/tail of the pancreas. There are two alternative technique to preserve splenic blood supply： Kiruma procedure and Warshaw procedure. Kiruma procedure is to preserve the splenic artery and vein during resection of distal pancreas ; Warshaw procedure is to ligate the splenic artery and vein when dissect the distal pancreas, whereas the short gastric vessels and gastroepiploic arteries and veins is preserved as the blood supply and drainage routes for the spleen. When dissect the vessels of spleen, the color of spleen needs to observe in case of occurrence of splenic infarction. Much of the operative procedure is identical in the two techniques. When splenic vascular injury occurs during pancreatectomy （usually involving the splenic vein） , it may be necessary to perform the Warshaw procedure in order to preserve the spleen. We describe the technique of laparoscopic spleen-preserving distal pancreatectomy with or without preservation of the splenic vessels .

关 键 词：胰腺肿瘤 胰腺切除术 腹腔镜检查 

分 类 号：R735.9[医药卫生—肿瘤]